“In the beginning, patients did not know the word ‘malaria’. It was a new word for them,” recalls Y. Sanjay Kumar, a health education supervisor working with MSF since 2007. “But nowadays some patients come to our clinic and say, ‘Help me. I have malaria’. They know that chills, fever and headache can mean malaria.”
It is a heartening development for Sanjay and his team, who work in remote areas of Andhra Pradesh, Chhattisgarh and Telangana to educate people about common diseases, their symptoms and treatment. And malaria, although preventable and easily treatable if diagnosed on time, remains a major health concern in these areas as a result of lack of awareness about the disease and unavailability of treatment. Perhaps an indication of the extent of the problem can be found in the fact that MSF treated over 13,000 people for malaria at its mobile clinics in 2015.
Mobile clinics take free healthcare to people living in remote forest villages who would otherwise have no access to it. Typically consisting of at least one doctor, a nurse, a lab technician, a translator and a health promoter, MSF’s mobile clinic teams reach areas difficult to access to deliver free medical care. In 2015, MSF conducted 21 different clinics every week at 14 different locations, providing free primary healthcare services including treatment for malaria, skin diseases, bacterial infections and diarrhoea, among others.
Tackling malaria through health education
(Left) A health education session underway in a village in Andhra Pradesh; health educators demonstrating the use of a mosquito net in Pusuguppa, Telangana. Photos: Camille Gillardeau; Sami Siva
MSF’s health educators travel to these locations and conduct awareness sessions with colourful charts illustrating the symptoms of malaria and precautions to take against it. Sometimes, these messages are also illustrated through group activities where people are invited to enact the role of a mosquito. As a preventive measure, the health promotion teams also distribute mosquito nets, especially to pregnant women.
At MSF’s mobile clinics, people with symptoms of malaria undergo a rapid diagnostic test and patients who test positive are given medication on the spot. “Patients get the first dose in the clinic and are counselled thoroughly about the dosage. We also explain the importance of adherence, telling the patient that while the fever may come down after the first pill, it is important to complete the full course,” Dr Naveen adds.
An MSF nurse takes a blood sample to check for malaria at a mobile clinic in Pusuguppa, a small village in Telangana along the border of Chhattisgarh. Photo: Sami Siva
“For severe cases of malaria, we don’t treat them at the clinics. We refer them to facilities in Bhadrachalam, Telangana – where MSF is based – for blood transfusion or any other support,” he says, adding that sometimes patients have also been referred to Hyderabad and Warangal. From reimbursing the cost of travel from and back to their village to covering the medical and food expenses at the hospital to which they have been referred, MSF’s medical teams support the patient throughout their treatment.
Challenges
However, treating malaria in these areas is not without its challenges. Owing to poor health seeking behavior among the local population, there is reluctance to access secondary care – even in situations where there is a clear risk to life. “Recently we met a pregnant lady with severe malaria at one of our mobile clinics. We referred her to Bhadrachalam and Hyderabad, but she ended up not going,” recounts Dr Naveen. “From unfamiliarity with the language to the fear of getting arrested, they have a number of reasons to not venture out of their village.” Depending on the place, tribals speak either Koya or Gothikoya dialects and not Telugu, the language spoken in Telangana and Andhra Pradesh.
The remote context also makes disease management and patient follow-up a challenge. “In a city you can admit a malaria patient, follow-up for as long as it is necessary and let them go when they are cured. But in a remote context, where there are no hospitals, you cannot do that. You do not know whether they are taking the medicines or not,” explains Dr Srinivas Rao, who has worked with MSF in Bhadrachalam earlier.
Through sustained health education, it is hoped that these challenges will be overcome. As we enter another peak season of malaria transmission, MSF’s teams are hard at work, ensuring lives are not lost to a deadly disease.
